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Advisory Council on the Misuse of Drugs. (2013) ACMD consideration of tramadol. London: Advisory Council on the Misuse of Drugs.

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Briefing from the Chair of the ACMD to the UK Home Secretary and Secretary of State for Health on Tramadol.

Tramadol is a synthetic analogue of the phenanthrene alkaloid codeine and is an analgesic of significant medical use for treating moderate to severe pain. Tramadol has wide ranging applications, including the treatment of fibromyalgia (chronic widespread pain), cancer pain and moderate to severe musculoskeletal pain. In a similar way to other psychoactive agents of the opioid class, it can be liable to misuse.

Tramadol has a unique dual-action pharmacological profile that increases the risk of adverse effects seen in overdose. Opioids such as tramadol exhibit weak agonist activity at opiate receptors in the brain and may contribute towards euphoria and respiratory depression. In addition, tramadol enhances serotoninergic and noradrenergic systems in the brain by inhibiting their reuptake mechanisms.

Prescribing data from the UK NHS Business Services Authority (NHSBSA) indicate an increase in prescribing, with the number of Daily Defined Doses (England)1 increasing from approximately 5.9 million in September 2005 to 11.1 million in September 2012. This may be associated with Co-Proxamol‟s phased withdrawal from 2005.

Data from the UK Office of National Statistics (ONS) for 2011 shows 154 deaths where tramadol had been mentioned on the death certificates; in 2009 there were 87 such mentions and in 2008 this figure was 83. The majority of tramadol related deaths are where it has been obtained through non–prescribed means.

Item Type
Publication Type
International, Report
Drug Type
Opioid, Prescription/Over the counter
Intervention Type
Harm reduction
February 2013
20 p.
Advisory Council on the Misuse of Drugs
Corporate Creators
Advisory Council on the Misuse of Drugs
Place of Publication
Accession Number
HRB (Electronic Only)
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